COMPARI NG 3 S T UDI E S

CALCULATING ENERGY NEEDS IN

THE CRITICALLY ILL OBESE
PATIENT
ICE BREAKER
Prediction equation preference for critically ill obese patients.
CRITICALLY ILL OBESE PATIENTS
NHANES 2009-2010
obesity data and
CDC
Obese critically ill
pts have more
complications
Mortality
LOS
CURRENT RECOMMENDATIONS
ASPEN guidelines
Evidence is more
difficult with mixed
ICU and non-ICU
patients
Eucaloric feeding
provide superior
outcomes?

THE ARTICLES
Comparison of resting energy expenditure
prediction methods with measured resting energy
expenditure in obese, hospitalized adults
Anderegg, B.A. et al. (referred to as Anderegg article)
Assessment of resting energy expenditure of obese
patients: Comparison of indirect calorimetry with
formulae
Alves, V. et al. (referred to as Alves article)
Prediction of resting metabolic rate in critically ill
patients at the extremes of body mass index
Frankenfield, D.C. et al. (referred to as Frankenfield article)




THEIR PURPOSE
Anderegg: determine which strategy most accurately
predicts REE within 10% of measured energy expenditure
(MREE).
Equations: Harris Benedict (H-B), Mifflin-St. Jeor, Ireton
Jones, 21 kcal/kg body weight, and 25 kcal/kg body
weight
Alves: compare REE measured by IC with that estimated
Equations: H-B, Ireton-Jones, and 21 kcal/kg
Frankenfield: validate the Penn State equation in
morbidly obese and to test the validity of other
equations in same patients, predictions within 10% MREE
Equations: H-B (ABW), Mifflin-St. Jeor (ABW), 21 and 25
kcal/kg, Ireton-Jones, and the Faisy equatio
*All used ABW, AdjBW, and AveBW

THE STUDY PARTICIPANTS
Anderegg: 36 patients, current cohort, single center study
design
BMI: mean 38.2 kg/m^2 (>/= 30 kg/m^2 criteria)
Sex, age
Dissimilar prognosis, small sample
Alves: 44 patients, current cohort, prospective study design
BMI: Mean 36.4 +/- 10.6.
Sex, age
Varying diagnoses and prognosis
Frankenfield: 55 patients, current cohort, mechanically vented
BMI: Mean 57.7 +/- 12.2 kg/m^2 (>/= 45 kg/m^2 criteria)
Sex, age
Similar prognosis in obese group


STUDY SEQUENCE/METHOD:
ANDEREGG
IC by metabolic
cart (done by resp.
therapists) in vented
patients and
MedGem handheld
IC (done by RDs) in
non-vented patients
Criteria
STUDY SEQUENCE/METHOD: ALVES
IC by DELTATRAC on
all patients either on
mechanical
ventilation or with
the use of a canopy
Evaluated twice
Criteria

STUDY SEQUENCE/METHOD:
FRANKENFIELD
IC by DELTATRAC MB-101

Process

Criteria
RESULTS REVIEW
Study Best predictive equation compared to MREE
Anderegg H-B, AdjBW and stress factor of 1.5 (critically ill) and 1.2
(general ward) 50% of values within 10% of MREE
Correlation with MREE: r = 0.59, moderate
Alves Fasted State: H-B AveBW, correlation: r = 0.79, strong.
Predicted 91% of MREE
H-B ABW, correlation: 0.78, strong. Predicted 104% of MREE
Fed State: H-B ABW, correlation: r = 0.84. Predicted 96% of
MREE
Ireton-Jones AdjBW, correlation: r = 0.81. Predicted 108% of
MREE
Frankenfield Penn State equation (standard regardless of age): 80% of
values within 10% of MREE.
Penn State equations (one for <60 year olds, one for <60
year olds): 76% of values within 10% of MREE errors evenly
divided = unbiased
PE RCE NT AGE OF PAT I E NT S WI T HI N 10% MRE E
ANDEREGG RESULTS
I C VS . PRE DI CT I ON E QUAT I ON
ALVES RESULTS (FASTED)
I C VS . PRE DI CT I ON E QUAT I ON
ALVES RESULTS (FED)
PRE DI CT I ON E QUAT I ON ACCURACY
FRANKENFIELD RESULTS
STUDIES VS. ASPEN
PSU when IC not
available
Mifflin-St Jeor when
PSU not available
Anderegg results
Frankenfield results
DISCUSSION
Do you agree with any of the articles findings?

What about ASPEN guidelines?

How often is PSU used when possible?
IN CLOSING
ASPEN guidelines:
IC is the gold standard
Use PSU
Use Mifflin-St Jeor

Whats the next big question?
Hypocaloric, high protein
Other emerging research?

REFERENCES
Alves VGF, da Rocha, Eduardo Eiras Moreira, Gonzalez MC, da Fonseca,
Rosana Barcellos Vieira, Silva, Mnica Hissa do Nascimento, Chiesa CA.
Assessement of resting energy expenditure of obese patients:
Comparison of indirect calorimetry with formulae. Clinical Nutrition.
2009;28(3):299-304. Accessed 4/30/2014 7:04:14 PM.
Anderegg BA, Worrall C, Barbour E, Simpson KN, DeLegge M. Comparison
of resting energy expenditure prediction methods with measured resting
energy expenditure in obese, hospitalized adults. Journal of Parenteral
and Enteral Nutrition. 2009;33(2):168-175. Accessed 4/30/2014 6:55:48 PM.
doi: 10.1177/0148607108327192.
Choban P, Dickerson R, Malone A, Worthington P, Compher C, and the
American Society for Parenteral and Enteral Nutrition. A.S.P.E.N. clinical
guidelines: Nutrition support of hospitalized adult patients with obesity.
Journal of Parenteral and Enteral Nutrition. 2013. Accessed 4/30/2014
7:07:56 PM. doi: 10.1177/0148607113499374.
Frankenfield DC, Ashcraft CM, Galvan DA. Prediction of resting metabolic
rate in critically ill patients at the extremes of body mass index. Journal of
Parenteral and Enteral Nutrition. 2013;37(3):361-367. Accessed 4/30/2014
6:57:05 PM. doi: 10.1177/0148607112457423.
QUESTIONS?